Dry Beriberi Presented By: Allister Liu Jennifer Ng Jessica Ng

What is Dry Beriberi?  A vitamin deficiency disease caused by inadequate bodily stores of thiamine.  It can damage the heart and nervous system.

What is Thiamine?  Also called Vitamin B1  Found in both plants and animals  Mainly lean pork, beef, liver, peas, beans, whole or enriched grains and breads  Assists in metabolism and processing of food taken in by the body  Required to form an important coenzyme known as Thiamine Pyrophosphate (TPP)

Thiamine Pyrophosphate

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Overview  Two major manifestations: 1) wet beriberi: a cardiovascular disease 2) dry beriberi: a nervous system disease  Both types caused by a deficiency in thiamine (vitamin B1), which can be precipitated by excessive alcohol consumption or a diet high in white rice.  Nervous system symptoms caused by the degeneration of nerve fibers and their insulation  Heart failure is the most common cause of death in people with beriberi.

Photo provided by Allister Liu

Signs and Symptoms 1)Early neurologic symptoms :  Complaints of symmetric tingling or burning pain in the extremities  Numbness in the extremities  Vomiting  Strange eye movements (nystagmus) 2)Later neurologic symptoms:  Mental confusion/speech difficulties  Difficulty walking  Coma  Death 3)Heart Failure Symptoms:  Shortness of breath with exertion  Symmetric swelling of the lower legs  Awakening at night short of breath 4) GI Symptoms:  Loss of appetite  Indigestion  Severe constipation  Lack of hydrochloric acid in the stomach

Signs and Symptoms

Complications 1)Psychosis 2)Coma 3)Congestive heart failure 4)Death

Diagnosis and Tests  Tests include: 1)Measurement of blood thiamine and whole-blood or erythrocyte transketolase activity 2)Measurement of urinary thiamine excretion 3)Clinical response to administered thiamine  person with late-stage beriberi may be confused or have memory loss and delusions.  A physical examination may show signs of congestive heart failure  Neurological examination may show a loss of vibratory sensation, decreased reflexes, loss of coordination, gait changes, nystagmus, ptosis, and opthalmoplegia

Cardiac enlargement in a pig. On the left, the heart of a normal pig. On the right, the heart of a thiamin deficient pig.

Treatment 1)Administration of thiamine by injection and with pills. 2)Patients should also receive therapeutic doses of other water-soluble vitamins.

Prognosis  Cardiac damage usually reversible  Full recovery is expected after treatment  However in conjunction with acute heart failure recovery rate is greatly reduced  Nervous system damage also reversible, if caught early.  If not, symptoms such as memory loss may not be completely recovered with treatment.  Untreated beriberi is often fatal.

Prevention  Adequate intake of thiamine, particularly by pregnant or breast-feeding women  Heavy drinkers should try to cut down or quit and supplement diets with B-vitamins to ensure appropriate intake of thiamine.

References (1) “Beriberi.” AllRefer Health Ericson, Karen., RN. “Beriberi.” Health AtoZ – Your Family Health Site < Hart, Jacqueline A., M.D. “Beriberi.” MedlinePlus Medical Encyclopedia. 06 January Hart, Jacqueline A., M.D. “Beriberi.” MedlinePlus Medical Encyclopedia. 06 January Kirk, Terence S. “The Secret POW Camera.” Photo. Leatherneck – Magazine of the Marines Ophardt, Charles, E. “Formation of Acetyl CoA from Pyruvic Acid.” Photo. Virtual Chembook Elmhurst College < Sewell, R Andrew., MD and Lawrence D Recht, MD. “Nutritional Neuropathy.” eMedicine. 15 September

References (2) “Thiaminases.” Cornell University. 4 October < “Thiamine Hydrochloride.” Photo. Neogen Corporation. 13 February “Thiamine Pyrophosphate.” Photo. Chups. < “Vitamin B1, Thiamine.” Photo. Healthmart February < “Vitamin B1 (Thiamine).” University of Maryland Medical Center < Woodbury, Charles. “Thiamine Pyrophosphate.” University of Illinois at Chicago. 05 January January 2005.

“Lucky Charms?”

Summary Slide  A vitamin deficiency disease caused by inadequate bodily stores of thiamine.  Thiamine:  Vitamin B1  Found in both plants and animals  Mainly lean pork, beef, liver, peas, beans, whole or enriched grains and breads  Assists in metabolism and processing of food taken in by the body  Required to form an important coenzyme known as Thiamine Pyrophosphate (TPP)  made up of pyrimidine + thiazole + 2 phosphates  TPP is required in the Krebs Cycle to convert pyruvic acid into Acetyl CoA, generating NADH for the electron transport chain  Signs and Symptoms 1) Early neurologic symptoms : tingling/pain and numbness in extremities, vomiting, nystagmus 2)Later neurologic symptoms: mental confusion, speech difficulties, difficulty walking, coma, death 3)Heart Failure Symptoms: SOB (leading to disturbed sleep), symmetric swelling of lower legs 4)GI Symptoms: loss of appetite, indigestion, severe constipation, lack of HCl in stomach  Complications: Psychosis, Coma, Congestive Heart Failure, Death  Diagnosis  person with late-stage beriberi may be confused or have memory loss and delusions.  A physical examination may show signs of congestive heart failure  Neurological examination may show a loss of vibratory sensation, decreased reflexes, loss of coordination, gait changes, nystagmus, ptosis, and opthalmoplegia  Tests 1)Measurement of blood thiamine and whole-blood or erythrocyte transketolase activity 2)Measurement of urinary thiamine excretion 3)Clinical response to administered thiamine  Treatment 1)Administration of thiamine by injection and with pills. 2)Patients should also receive therapeutic doses of other water-soluble vitamins.